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Re: Clomiphene Induced Cysts & Hydrosalpinx Lead to Fertility ProblemsFrom: Laurie (anonymous@obgyn.net)Wed, 21 May 1997 08:29:37 -0500 (CDT)
At Wed, 21 May 1997, Mary wrote: One cyst on my left >ovary measured 5 cm and the one on the right slightly larger than 3 cm. >On 5/16/97, another cyst-like structure formed - possibly a hydrosalpinx >on the left fallopian tube associated with the 5 cm cyst. This >structure is also approximately 5 cm. The other 2 cysts have not gotten >any smaller.
My hope
>is that these will resolve on their own as quickly as possibly and with These cysts will almost certainly resolve on their own with no damage to your system. The largest cysts I've seen on the lowest (50 mg) dose of clomiphene were 10 cm each (3 separate cysts). They took two months to resolve. This patient is now taking 25 mg clomiphene, less than the lowest dose. She, however, is different from you, in that she does not ovulate on her own.
>1) Have these gigantic cysts caused any scarring inside my ovaries that No.
Would the
>surrounding cellular architecture be changed ? Probably yes, but in the same way that the ovulatory follicle each month also changes the cellular architecture.
Would they form any kind
>of fibrous type of shell? No.
If they do shrink and not rupture, would the
>scars be of normal size - like those from a normal corpus luteum and Yes.
I am worried that this incident would
>hasten the lifespan ability of my ovaries to produce follicles. Hopefully my fears are unfounded.
I think these concerns ARE unfounded. Many women worry that agents that
induce the ovulation of more than one egg each cycle will "use up" the
ovary's eggs sooner. In actuality, eggs undergo a process called
atresia all the time, in which extra, unovulated eggs die off on their
own. Women have so very very many eggs per ovary that they couldn't be
all "used up" even with the combination of multiple ovulations and
atresia.
> I don't know how clomiphene could have caused a hydrosalpinx. It can be hard to determine if a structure is a hydrosalpinx versus an ovarian cyst, particularly when there are many dilated structures in the same area. I wouldn't be surprised if this is just another ovarian cyst. Hydrosalpinx can cause mucosal damage inside the tube, particularly if present chronically (years) and if massively dilated.
Could this hydrosalpinx (cyst) cause a
>blockage (either complete or partial) that may cause problems later on Technically, yes, but one blocked tube doesn't statistically lessen your chance of pregnancy unless the unblocked tube is also affected by the same disease process. And even if you ovulate from the left ovary, that egg could be picked up by the right tube.
> While this situation has caused you a frustrating delay, I don't at all feel that it is dismal. You could look at this as evidence that at least your ovaries ARE responding. Try not to be too hard on yourself--it's only natural to want to do all you can when you're trying to become pregnant. Again, this is a frustrating delay, but this situation should resolve completely and let you get on with your original plans! Best of luck,
-- Laurie Lovely, MD RE fellow, UNC-Chapel Hill
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